Xaysanasy, Phetsamone Peter

Xaysanasy, Phetsamone Peter is an individual health care provider with primary practice located at 125 W Sunbridge Dr Suite 1, Fayetteville AR 72703-1899. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Xaysanasy, Phetsamone Peter can be contacted via phone (479) 251-9200.

Contact Information

Primary practice address
125 W Sunbridge Dr Suite 1 Fayetteville AR 72703-1899
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 193 Arkansas

Profile Details

NPI number 1063456184
LBN Legal business name Xaysanasy, Phetsamone Peter
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Jan 3rd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063456184 NPPES
Arkansas MEDICAID 14086717

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